Indiana counties must fund needle exchanges without state help

One of Indiana's four legal needle exchange programs operates out of a cramped 10 foot-by-10 foot office in the basement of the courthouse in Fayette County, which is struggling with a hepatitis C outbreak amid the state's growing opioid-abuse crisis.

Though just seven intravenous drug users addicted to heroin are enrolled in the program, Paula Maupin, Fayette County's public health nurse, expects that to grow to 75 to 100 participants in the next year or so. The problem is, lawmakers banned state funding for the exchanges when they legalized them last year, even as Indiana's worst-ever HIV outbreak struck in another county.

The four counties — Fayette, Madison, Monroe and Scott — that won state approval for their exchanges after that law took effect last May are cash-strapped and in largely rural areas. They had to scramble to find money from nonprofits, foundations, donations or county coffers to run the programs, which provide intravenous drug users with clean syringes and collect used ones to reduce needle-sharing and prevent the spread of HIV, hepatitis C and other diseases. But local officials are hoping federal funding can give them a boost.

Fayette County turned to the Comer Family Foundation and the Washington-based advocacy group AIDS United, which provided $23,000. Although its exchange won state approval in August, it didn't open in Connersville, about 50 miles east of Indianapolis, until November.

"What we've got, it's fine for now," Maupin said Thursday as she stood next to baskets of clean syringes, packaged cotton balls and other supplies. "But when we have the amount of people I'm expecting, we're going to burn through that money pretty quick."

State Rep. Ed Clere, a New Albany Republican, acknowledged that the state funding ban is "a real barrier" that counties must overcome, but that it's necessary to win the votes of lawmakers.

"Without the change in law, syringe exchanges wouldn't have been possible, period," he said of the legislation he authored, which requires the state health commissioner to review and either approve or reject the creation of exchanges for counties that seek them.

Clere said he's hopeful that Congress' move in December to soften a longtime ban on federal funding for needle exchanges, made in response to the nation's opioid abuse crisis, will open a flow of federal dollars to help the county exchanges pay employees' salaries, rent office space and support other aspects. That money, however, can't be used to buy clean needles.

The Centers for Disease Control and Prevention is still drafting rules for applications for federal funding. "The devil will be in the details" of the CDC's process to identify priority areas for funding, said Beth Meyerson, co-director of the Rural Center for AIDS/STD Prevention at Indiana University.

"Obviously they're not going to have funding for every county that wants to initiate a syringe exchange locally. And many of these counties are very poor," she said. Fayette County is among them, having seen several factories close in recent years. And Meyerson said she expects more than 20 other Indiana counties to seek approval for a needle exchange.

Scott County, about 30 miles north of Louisville, Kentucky, was at the heart of the HIV outbreak that spurred the change in Indiana's law. It's operated its exchange since April 2015 — initially under an executive order signed by Gov. Mike Pence and later under the new law. Two hundred people are actively participating in the county's exchange, public health nurse Brittany Combs said, and nearly 400 have signed up to take part.

Combs said the HIV outbreak — the worst in Indiana history with nearly 190 people infected and driven largely by people abusing a liquefied form of the prescription painkiller Opana — has "definitely been stopped" by the needle exchange and robust local education efforts targeting IV drug users.

It has remained afloat with grants and donations from several groups, including $10,000 from the Indiana Family Health Council, but will need much more in the years ahead. She hopes federal dollars can arrive sometime this year to boost the county's efforts.

"That would really be great. We're kind of in a waiting game right now," Combs said.